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Embedding Medical Students in the Emergency Department: The Teachable Moments
Abstract
Emergency departments (EDs) are busy places with various processes and activities going on simultaneously. As a result of this, there is much interaction, communications and coordination at any point in time. EDs are also places where there are many good signs and symptoms for medical students to do their learning. They provide a very rich learning and teaching environment.
Fourth year medical students doing their Emergency Medicine rotation, were embedded into small teams with residents and faculty for their experiential learning process, for the clinical part of the programme. This allowed them to have a lot of hands-on practice, a realistic picture of the acute presentations ED patients had, empowerment to perform procedures under appropriate supervision and a lot of informal interaction and communications with emergency physicians. The small teams provided the students with a small students to faculty ratio and lots of opportunities to learn and ask questions. This pilot programme has obtained very positive feedback from both students and faculty, and will thus be expanded and strengthened further in the new academic year. Embedding enables both students and faculty to seize the ‘teachable moments’ any opportunity they have, to make the best use and benefit from them.
... This way, they get to learn through building up their experiences. This is all part and parcel of the process of grooming and developing our emergency physicians of the future (8)(9). It is part of their professional growth cycle. ...
... It is part of their professional growth cycle. This way they get to harness their clinical and critical reasoning processes and thought processes in approaching patients or issues in healthcare (9,16). Faculty can prompt, assist and also educate them and this is done at strategic points, which will help them remember better. ...
... During pandemics, we have to rethink about how medical education is conducted and delivered. There would probably be an increase in the use of technology, but this has to be of the correct balance and combination in order to maintain realism, credibility and capabilities (5,9). At the same time, issues of maintaining confidentiality and ensuring cyber-security must be mainstreamed (10,16). ...
To learn the practice of medicine, one must practice medicine. To maximize opportunities for practice, medical students are often embedded into functioning healthcare teams. At the National University of Singapore, students are distributed for clinical training at a variety of sites across the country. To enhance consistency of experience, the principles of embedding were clarified by a consensus-driven process and implemented according to local context. The principles are that embedding is safe for students and patients, independent thought, and commitment are required, students add value to the team, and that timely meaningful feedback is given. During the implementation phase, many lessons were distilled to further improve the process of student embedding.
Many teachers see major difficulties in maintaining academic standards in today's larger and more diversified classes. The problem becomes more tractable if learning outcomes are seen as more a function of students' activities than of their fixed characteristics. The teacher's job is then to organise the teaching/learning context so that all students are more likely to use the higher order learning processes which "academic" students use spontaneously. This may be achieved when all components are aligned, so that objectives express the kinds of understanding that we want from students, the teaching context encourages students to undertake the learning activities likely to achieve those understandings, and the assessment tasks tell students what activities are required of them, and tell us how well the objectives have been met. Two examples of aligned teaching systems are described: problem-based learning and the learning portfolio.
To determine if a dedicated teaching attending for medical student education improves medical student, attending physician, and resident perceptions and satisfaction.
Two dedicated teaching attending physician shifts were added to the clinical schedule each week. A before-after trial compared medical student evaluations from 2000 to 2004 (preteaching attending physician) to medical student evaluations from 2005 to 2006 (teaching attending physician). Attending physician and resident perceptions and satisfaction with the teaching attending physician shifts using a 5-point Likert-type scale (1 = poor to 5 = excellent) were also assessed.
Eighty-nine (100%) medical students participated, with 63 preteaching attending physician and 26 teaching attending physician rotation evaluations. The addition of teaching attending physician shifts improved mean medical student satisfaction with bedside teaching (4.1 to 4.5), lecture satisfaction (4.2 to 4.8), preceptor scores (4.3 to 4.8), and perceived usefulness of the rotation (4.5 to 5.0) (all p < 0.05). Thirteen attending physicians (93%) participated in the cross-sectional questionnaire. The addition of teaching attending physician shifts improved faculty ratings of their medical student interactions by ≥ 1.5 points for all items (p ≤ 0.001). Faculty perceptions of their resident interactions improved for quality of bedside teaching (3.1 to 4.0), their availability to hear resident presentations (3.4 to 4.2), and their supervision of residents (3.4 to 4.1) (p ≤ 0.01). Residents (n = 35) noted minor improvements with the timeliness of patient dispositions, faculty bedside teaching, and attending physician availability.
The addition of select teaching attending physician shifts had the greatest effect on medical student and faculty perceptions and satisfaction, with some improvements for residents.
Dual-process psychological theories argue that clinical decision making is achieved through a combination of experiential (fast and intuitive) and rational (slower and systematic) cognitive processes.
To determine whether emergency physicians perceived their clinical decisions in general to be more experiential or rational and how this compared with other physicians.
A validated psychometric tool, the Rational Experiential Inventory (REI-40), was sent through postal mail to all emergency physicians registered with the College of Physicians and Surgeons of Ontario, according to their website in November 2009. Forty statements were ranked on a Likert scale from 1 (Definitely False) to 5 (Definitely True). An initial survey was sent out, followed by reminder cards and a second survey to non-respondents. Analysis included descriptive statistics, Student t tests, analysis of variance and comparison of mean scores with those of cardiologists from New Zealand.
The response rate in this study was 46.9% (434/925). The respondents' median age was 41-50 years; they were mostly men (72.6%) and most had more than 10 years of clinical experience (66.8%). The mean REI-40 rational scores were higher than the experiential scores (3.93/5 (SD 0.35) vs 3.33/5 (SD 0.49), p<0.0001), similar to the mean scores of cardiologists from New Zealand (mean rational 3.93/5, mean experiential 3.05/5). The mean experiential scores were significantly higher for female respondents than for male respondents (3.40/5 (SD 0.49) vs 3.30/5 (SD 0.48), p=0.003).
Overall, emergency physicians favoured rational decision making rather than experiential decision making; however, female emergency physicians had higher experiential scores than male emergency physicians. This has important implications for future knowledge translation and decision support efforts among emergency physicians.
Despite growing recognition of the need to increase cultural diversity undergraduate education in the UK, the US and Canada, there is a lack of cohesion in the development and delivery of cultural diversity teaching in medical schools in these three countries. This article highlights 12 tips for developing cultural diversity education in undergraduate medical programmes by integrating it in institutional policies, curriculum content, faculty development and assessment. These tips can be used to help ensure that students gain needed knowledge, skills and attitudes consistent with a view of patients as complex individuals with unique needs.
This article considers how doctors learn to reason in the clinical environment and recommends practical approaches that clinical teachers can use to promote the development of strong diagnostic reasoning skills in their students.
The quality of an individual's learning is influenced significantly by the quantity of mental processing they are required to manage in a clinical learning situation. Some clinical learning settings require the learner to process high levels of complex knowledge and skills, whilst simultaneously monitoring and responding to challenging social or emotional inputs. This paper introduces the concept of 'cognitive load', its negative impacts upon novice learners in particular, and its real-world implications for teaching and supervision.
Narrative review and discussion.
The concept of cognitive load is reviewed, and examples of its application to clinical learning and teaching are provided. Teaching and supervision strategies for managing the cognitive load of learners are presented.
The clinical teacher has significant capacity to reduce the cognitive load of learners by creating safe and supportive learning environments, establishing trusting relationships with the learner, and implementing structured learning experiences that are designed to support the learner's growth in knowledge, understanding and skills. A threefold focus on the nature of the learning task, the learning environment and the learner's perceptions of these elements, which characterises cognitive load, provides a useful framework for diagnosing poor learning behaviours and maximising learning outcomes.
One of the challenges of the Biotechnology industry is keeping up to date with the rapid pace of change and that much of the information, which students learn in their undergraduate studies, will be out of date in a few years. It is therefore crucial that Biotechnology students have the skills to access the relevant information for their studies and critically evaluate the vast volume of information and its sources. By developing information literacy skills, which are part of lifelong learning, Biotechnology graduates are better prepared for their careers. Students also need to understand the issues related to the use of information such as social, political, ethical, and legal implications. This paper will outline the embedding of information literacy skills within the Biotechnology degree at the University of South Australia. Examples of specific activities and their link to assessment will be discussed.
Institutions are increasingly considering interprofessional education (IPE) as a means to improve health care and reduce medical errors in the United States. Effective implementation of IPE within health professions education requires a strategic institutional approach to ensure longevity and sustainability. In 2007, the Medical University of South Carolina (MUSC) established Creating Collaborative Care (C), an IPE initiative that takes a multifaceted approach to weaving interprofessional collaborative experiences throughout MUSC's culture to prepare students to participate in interprofessional, collaborative health care and research settings.In this article, the authors describe C's guiding conceptual foundation and student learning goals. They present its implementation framework to illustrate how C is embedded within the institutional culture. It is housed in the provost's office, and an overarching implementation committee functions as a central coordinating group. Faculty members develop and implement C activities across professions by contributing to four collaborating domains-curricular, extracurricular, faculty development, and health care simulation-each of which captures an IPE component. The authors provide examples of IPE activities developed by each domain to illustrate the breadth of IPE at MUSC. The authors believe that MUSC's efforts, including the conceptual foundation and implementation framework, can be generalized to other institutions intent on developing IPE within their organizational cultures.
As the teaching activities of medical school faculty are given greater emphasis, medical schools must find a way to recognize and reward excellence in teaching. In order to properly evaluate teaching, the authors developed an instrument for measuring the various teaching activities of their faculty. The Relative Value Scale in Teaching weights all teaching activities according to labor intensity, preparation time, level of responsibility, and educational value. The scale quantifies levels of teaching and allows comparison among diverse teaching activities. This complements qualitative measures of teaching and can enhance participation in educational programs as well as recognition of educators.
Much of the student experience in theatre depends on the interaction between student and surgeon, and having the opportunity to take part in procedures. Theatre-based teaching can be seen as having little inherent benefit otherwise. We wished to identify other factors contributing to the experience of theatre-based teaching.
A questionnaire survey, using forced-choice and open questions, of undergraduate medical students with experience of surgical attachments.
54 final (5th) year medical students, University of Aberdeen.
Responses on the closed questions are presented as percentages. The themes arising from the open questions were identified and the relationships among these themes explored.
Student expectations of learning focused on knowledge acquisition. Students learning experiences varied widely, depending on how welcome they felt in theatre. Visibility and active participation influenced the experience. Students did not feel adequately prepared for getting the most out of this learning experience.
The student experience may be skewed by unrealistic expectations of theatre-based learning. Clear and realistic learning objectives, preparation in terms of familiarity with the environment and staff roles, embedding the experience in the patient's journey/care pathways, faculty expectations being clearly communicated to clinical teaching staff and, perhaps above all, approachability of theatre staff are likely to improve the learning experience.
Genetic Counselors (GCs) spend years learning about genetics and practicing counseling techniques in classroom environments. From the learner perspective, teaching may seem straightforward: provide appropriate information, develop tests or assignments and submit grades. When asked to teach for the first time, however, clinicians suddenly realize that there is a lot more to education than standing in front of a class and talking. This article introduces clinical educators to strategies and learning principles that help make the teaching/learning process more interesting and successful for faculty and students alike. The instructional concepts presented here are useful across the entire spectrum of learning situations; a 1 hour discussion with a lay audience, a 3 hour workshop at a professional meeting, a 15 week graduate course, or a series of courses culminating in an advanced degree. The article offers suggestions for writing course competencies, selecting instructional approaches, embedding learning engagement options, leveling course content and choosing evaluation strategies.
Job Shadowing is an effective and valuable learning tool
- P Graham
- S Tso
- E Wood
Graham P, Tso S, Wood E. Job Shadowing
is an effective and valuable learning tool.
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